Cell adhesion molecule 1 (CADM1) is an immunoglobulin superfamily cell adhesion molecule that was first identified as a tumor suppressor in non-small cell lung cancer because of its role in suppressing tumor formation in nude mice. CADM1 forms a homophilic dimer on the cell membrane and associates with actin-binding proteins (4.1s) and scaffold proteins (MAGuKs), which contain PDZ motifs. It forms a ternary protein complex involved in cell adhesion and the formation of epithelium-like structure. While CADM1 is expressed in epithelium, neuronal tissue, and testes, CADM1 expression is absent in many cancers of epithelial origin, including cancers of the lung, esophagus, stomach, liver, pancreas, breast, and prostate. In addition to its tumor-suppressive activity in epithelial cell adhesion, CADM1 acts as a tumor antigen, recognized by activated NK cells and CD8+ T cells through heterophilic interaction with CRTAM, thereby serving as a tumor suppressor in two ways. In contrast, CADM1 is overexpressed in adult T-cell leukemia/lymphoma (ATL) cells, making it a specific diagnostic marker of ATL on FACS analysis. CADM1 is also highly expressed in small cell lung cancer (SCLC) and other neuroendocrine tumors, and promotes metastasis, suggesting its potential as a target for diagnosis and treatment of SCLC. CADM1 also has a role in synapse formation and spermatogenesis, and deficient or abnormal CADM1 is linked to disorders such as male infertility in mice and autism spectrum disorder. Here, we summarize the multiple functions of CADM1 and its involvement in cancer and other diseases, focusing on disorders of aberrant cell adhesion.

Tarsal tunnel syndrome (TTS) is elicited by compression of the tibial nerve in the tarsal tunnel. TTS in the absence of a lesion tends to be idiopathic, and most TTS is idiopathic. Patients complain of several plantar symptoms, and TTS affects their quality of life. The symptoms tend to worsen with walking, and ankle joint movement and arterial distortion may also be involved. Because TTS symptoms are similar to those of diabetic neuropathy and lumbar disease, clinical symptoms are diagnostically important. While magnetic resonance imaging reveals nerve compression, it is difficult to identify causative factors, and false-positive results are a concern. Wound-related complications after TTS surgery may be reduced by a zigzag skin incision. Surgery for carpal tunnel syndrome yields better outcomes and greater patient satisfaction than TTS surgery.

During the period from September 5 to November 4, 1915 (Taisho 4), the bacteriologist Dr. Hideyo Noguchi temporarily returned to Japan after living and working in the United States for 15 years. This article discusses the many lectures he delivered during his visit, particularly those at the alumni meeting of Saisei-Gakusha, the institution from which he graduated, and the Mita Speech Meeting at Keio University. Additionally, this paper provides an overview of Saisei-Gakusha, a private medical school from the Meiji era that later became the predecessor of Nippon Medical School, highlighting its founding philosophy of "Saisei" (to save lives). It also introduces materials such as Noguchi's handwritten Curriculum Vitae and Autograph, which he prepared while studying abroad at the Rockefeller Institute for Medical Research. Furthermore, we examine an article from The New York Times reporting on Noguchi's serious illness several years after his return to the United States, as well as related articles from Japanese newspapers. We also present a thank-you postcard and a business card sent by Noguchi to his close friend Dr. Shinichi Wani, a fellow alumnus of Saisei-Gakusha, illustrating their enduring friendship. These materials reflect Noguchi's meticulous nature, thoughtful personality, and warm character, as seen through his relationship with his dear friend Wani.

Background: Atrial functional mitral regurgitation (MR) involves functional MR with left atrial (LA) dilatation and mitral annulus (MA) remodeling. The relationship between LA dilatation and MA remodeling, and the mechanism of MR associated with MA remodeling, are unclear and were investigated in this study. Methods: This single-center, cross-sectional retrospective study prospectively enrolled 97 consecutive patients with atrial fibrillation (AF) referred for three-dimensional transesophageal echocardiography. Mitral valve echocardiographic data of 18 AF patients with moderate or severe MR (MR group) and 79 with mild or less severe MR (non-MR group) were analyzed. Results: The LA volume index was larger and tenting height was lower in the MR group than in the non-MR group (63.9±17.9 mL/m² vs. 43.6±13.9 mL/m²; p<0.001; 3.9 mm vs. 4.9 mm; p = 0.041). Anteroposterior (AP) diameter, annulus area, and sphericity index (AP diameter/anterolateral-posteromedial diameter) of MA were larger in the MR group than in the non-MR group (30.1 mm vs. 26.4 mm; p<0.001; 8.8 cm² vs. 7.4 cm²; p = 0.002; 80.1% vs. 74.5%; p<0.001, respectively). Linear regression analysis indicated that AP diameter was moderately correlated with LA volume index (R = 0.535, p<0.001). The area under the receiver operating characteristics curve of the AP diameter for the association with significant MR was significantly larger than that for the annulus area (0.8003 vs. 0.7180; p = 0.003). Multivariable analysis revealed that AP diameter (p = 0.006) and sphericity index (p = 0.041) were independently associated with significant MR, but annulus area was not (p = 0.083). Conclusions: LA dilatation correlated with MA remodeling, primarily via enlargement of AP diameter. Circular change with AP diameter enlargement in MA may be a key mechanism of MR associated with MA remodeling.

Background: Constipation, a symptom of autonomic nervous system dysfunction affecting gastrointestinal motility, is common after acute ischemic stroke. The insular cortex is associated with autonomic symptoms, and damage to the left insula may result in constipation. We investigated the association between constipation and left-sided insular infarction in patients with acute stroke. Methods: We retrospectively analyzed data from consecutive patients who received a diagnosis of acute infarction in the middle cerebral artery territory between January 2015 and December 2018. Constipation was defined as bowel movements less often than three times a week or a prescription for laxatives within 2 weeks of stroke onset. Clinical characteristics and factors associated with constipation were evaluated. Results: Among 892 patients (mean age, 75 [66-82] years; male, 566 [63.5%]), 301 (32.8%) had constipation. Infarction involving the insula (57.7% vs. 25.1%) and left-sided infarction (62.5% vs. 46.4%) were more frequent in patients with constipation than in those without constipation. In multivariable analysis, infarction involving the insula (adjusted odds ratio [aOR], 2.30; 95% confidence interval [CI], 1.57-3.36; P<0.001), left-sided infarction (aOR, 1.93; 95% CI, 1.40-2.64; P<0.001), and baseline National Institutes of Health Stroke Score (aOR, 1.04; 95% CI, 1.01-1.06; P<0.001) were associated with constipation. The incidence of constipation was highest in cases of left-sided infarction with insular involvement (69.2%). Conclusions: Left-sided infarction, infarction involving the insular cortex, and baseline National Institutes of Health Stroke Score were identified as independent factors associated with constipation in patients with acute stroke.

Background: The optimal on-scene time after the return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) has not been established. This study aimed to investigate the relationship between the on-scene time after ROSC and neurological outcomes. Methods: We analyzed data recorded in the SOS-KANTO 2017 registry between September 2019 and March 2021. Patients with OHCA who achieved ROSC on the scene were included and categorized into three groups based on on-scene time after ROSC (0-<6 min, 6-<10 min, and ≥10 min). Comparisons were performed using multiple propensity score analysis. The primary outcome was favorable neurological status at one month, defined as cerebral performance categories 1 and 2. Results: In total, 331 patients were included. Favorable neurological outcomes at one month were observed in 29.1% (32/123) of patients in the 0-<6 min group, 37.2% (35/104) in the 6-<10 min group, and 36.3% (29/104) in the ≥10 min group. There was no significant association between shorter on-scene times (0-<6 min) and favorable neurological outcomes at one month compared to the other groups (adjusted odds ratio [AOR], 0.97; 95% confidence interval [CI], 0.39-2.41 for 6-<10 min; AOR, 0.90; 95% CI, 0.30-2.70 for ≥10 min). Conclusion: Differences in on-scene time after ROSC were not significantly associated with favorable neurological outcomes at one month. Future research should focus on identifying factors that may influence outcomes, and on exploring strategies to enhance care in the Japanese EMS context.

Background: Use of radiocolloids for sentinel lymph node (SLN) detection in breast cancer (BC) offers the advantage of utilizing single-photon emission computed tomography/computed tomography (SPECT/CT). This study explored whether SPECT/CT findings can predict pathological axillary lymph node (ALN) metastasis. Methods: A consecutive series of patients with invasive BC (clinical stage, T1-3, N0, and M0) who underwent SLN biopsy (SLNB) using SPECT/CT between January 2011 and December 2016 were included. SLN detection, location, and number on SPECT/CT, number of excised SLNs, and clinical and pathological characteristics were analyzed in relation to pathological ALN metastasis. Results: Data from 408 patients (412 cases) with BC were analyzed. Patient age ranged from 28 to 93 years (mean: 59). SPECT/CT identified one to four SLNs (mean: 1.3) in 407 cases (98.8%) and no SLNs in 5 cases (1.2%). Of the 407 cases with at least one identified SLN, SLNs were solely in level I of the axilla in 394 cases (96.8%), both in and outside level I in 12 (2.9%), and solely outside of level I in 1 (0.2%). The number of ALNs removed via SLNB ranged from one to eight (mean: 2.0). SPECT/CT findings, including absence of SLN detection (P<0.001), SLN locations outside of axillary level I (P<0.001), and an increased number of SLNs (P=0.034), as well as removal of ≥3 SLNs (P=0.028), were significantly correlated with pathological ALN metastasis. Conclusions: SLNB with SPECT/CT yields useful information on pathological ALN metastasis in BC patients.

Background: Details of in-hospital stroke are unknown. This study aimed to clarify the incidence rate and risk factors for in-hospital stroke among all inpatients. Methods: This retrospective single-center study included consecutive patients admitted to our hospital. Patients aged <18 years, discharged within 24 h, and admitted to the neurology and neurosurgery departments were excluded. The incidence rate for in-hospital stroke was calculated, and patients were divided into stroke and control groups based on ischemic stroke occurrence, and the risk factors were assessed using multivariate analysis. Results: Of the 83,990 enrolled patients, 101 (0.12%) developed stroke. The stroke group had a higher proportion of patients with older age (76 vs 69 years; P <.01), hypertension (49% vs 26%; P <.01), diabetes mellitus (34% vs 22%; P =.01), atrial fibrillation (25% vs 8%; P <.01), cardiovascular disease (20% vs 11%; P =.01), and emergency admission (68% vs 32%; P <.01) compared to the control group. The risk factors for in-hospital stroke were old age (odds ratio [OR], 1.03; P <.01), hypertension (OR, 1.57; P =.04), diabetes mellitus (OR, 1.61; P =.03), atrial fibrillation (OR, 2.43; P <.01), emergency admission (OR, 3.38; P <.01), and low serum albumin (OR, 0.66; P =.03). Conclusion: The incidence rate of in-hospital stroke was 0.12% and the independent risk factors were old age, history of hypertension, diabetes mellitus, atrial fibrillation, emergency admission, and low serum albumin.

Background: Diuretics are commonly used to reduce renal dysfunction during cisplatin-based chemotherapy; however, reports suggest that renal function is unaffected when diuretics are not administered. This phase II trial evaluated the effectiveness and safety of a short hydration method without diuretics. Methods: Patients were included if they were aged 20-74 years, had a thoracic malignancy for which a cisplatin-based regimen (dose: ≥60 mg/m²) was indicated, and had adequate renal function. All patients received cisplatin-based chemotherapy using a short hydration method without diuretics. The primary endpoint was the proportion of patients without grade 2 or higher elevations in creatinine levels during the first cycle of cisplatin. Results: Forty-six patients were enrolled between June 2019 and April 2022. The patients included 38 men and 8 women with a median age of 64 years (range: 45-74 years). Of these, 13 patients received adjuvant chemotherapy, 19 received chemoradiotherapy, 1 received chemotherapy for post-surgical recurrence, and 13 received chemotherapy for advanced disease. The median number of chemotherapy cycles was 3 (range: 1-4). A total of 93.5% (43/46) of the patients completed cisplatin-based chemotherapy without grade 2 or higher creatinine elevation during the first cycle, and 84.8% (39/46) of participants, including those who discontinued treatment, did not show grade 2 or higher creatinine elevation after all cycles of cisplatin-based chemotherapy. Conclusions: Short hydration without diuretics is safe for patients receiving cisplatin-containing chemotherapy. Randomized trials with or without diuretics in this setting are warranted.

Background: Perioperative prophylactic antimicrobials are re-administered at intervals of twice their half-life. However, the actual concentrations of antimicrobial agents and the degree of elevation remain unelucidated. Methods: This prospective cohort study was conducted at a single tertiary care center. Serum concentrations were evaluated in patients who underwent hepatobiliary-pancreatic surgery between April 2019 and December 2020 and received an additional dose of flomoxef (FMOX) every 3 h or 5 h during the surgical procedure based on their renal function. Results: Among the 31 participants, 25 and six received FMOX every 3 h and 5 h, respectively. Analysis based on renal function revealed median FMOX concentrations of 9.88 mg/L and 9.85 mg/L (p = 0.09) for patients with creatinine clearance (Ccr) >60 mL/min and 14.26 mg/L and 20.03 mg/L (p = 0.02) for the patients with Ccr ≤60 mL/min at 3 h and 6 h, respectively, with notable elevation at Ccr ≤60 mL/min. Moreover, the serum FMOX concentration at 6 h for the 3-h dosing patients with Ccr ≤60 mL/min was significantly higher than the concentration at 5 h for the 5-h dosing patients with Ccr ≤60 mL/min (20.03 mg/L vs. 12.85 mg/L, p = 0.04). Although serum concentrations at 3-h and 6-h intervals did not differ significantly in patients with Ccr ≥60 mL/min, these significantly increased in patients with Ccr <60 mL/min. Conclusions: Administering FMOX every 3 h when Ccr is ≥60 mL/min and every 5 h when Ccr is <60 mL/min are appropriate.

Background: Prostate cancer (PCa) significantly contributes to male cancer mortality. Triplet therapy shows promise for metastatic castration-sensitive prostate cancer (mCSPC), but real-world data are limited. This study aimed to evaluate the clinical outcomes of triplet therapy in real-world patients with mCSPC at an academic hospital in Japan. Methods: We retrospectively analyzed the efficacy and safety of triplet therapy, comprising androgen deprivation therapy, docetaxel, and darolutamide, in patients with mCSPC at Nippon Medical School Hospital. Clinical outcomes, adverse events (AEs), prostate-specific antigen (PSA) responses, and progression to castration-resistant prostate cancer were assessed. Results: Between January 2023 and June 2024, we identified 14 Japanese patients with mCSPC who received triplet therapy. All patients presented with synchronous high-volume metastases as defined by the CHAARTED criteria. The median follow-up period was 7.9 months. In terms of efficacy, all 14 patients achieved PSA reduction of > 90%, while 13 of them achieved reductions of > 99%. AEs were reported in all patients, with grade 3 or higher AEs occurring in 10 patients. One patient permanently discontinued treatment and 4 patients temporarily interrupted therapy due to AEs. During follow-up, biochemical progression was observed in 2 patients and radiological progression in 2 patients. Subsequent therapies were selected based on each patient's clinicopathological and genetic characteristics, with considerable variability in treatment approaches following progression. Conclusions: While PSA responses were favorable and tolerability was generally high, progression patterns and subsequent therapies varied widely, highlighting the need for close monitoring and individualized treatment in patients with mCSPC receiving triplet therapy.

Fulminant type 1 diabetes mellitus (fulminant T1DM) can progress rapidly to diabetic ketoacidosis (DKA). It can develop in pregnant women with no prior history of diabetes, and such cases are associated with severe perinatal consequences. We report the detailed clinical course of a neonate born from a mother with DKA caused by fulminant T1DM. The male neonate weighed 3,024 grams and was born at 36 weeks of gestation. The patient's mother had an uneventful pregnancy until she visited the hospital on the day of delivery with headache, nausea, and decreased fetal movement. The APGAR score of the neonate was 8/8, but he was transferred to our hospital for further evaluation because umbilical cord blood gas analysis showed unexplained acidosis (pH = 6.92). We were later informed that the mother was diagnosed as having DKA due to fulminant T1DM after the neonate was born. On admission, laboratory testing of the neonate revealed hypoglycemia, hyperinsulinemia, and hyperkalemia, all of which were induced by the mother's metabolic condition. Intravenous glucose supplementation resolved the neonate's metabolic derangement, and he was discharged on day 10. He showed no neurological abnormalities, but magnetic resonance imaging showed lesions indicating hypoglycemic encephalopathy. Maternal fulminant T1DM and DKA should be considered in neonates with severe metabolic acidosis. Even a neonate who is asymptomatic at birth may rapidly develop severe disease.

Prosopagnosia is a cognitive disorder in which facial recognition is severely impaired despite normal vision and intelligence. Prosopagnosia was first reported in the 1800s, but its cause remains unclear. Although other neurological symptoms are often present, some patients have pure prosopagnosia. The bilateral occipital lobes are believed to be associated with symptoms. Recent brain imaging techniques have identified the right fusiform gyrus (rFG), located at the junction of the right occipital temporal lobe, as the affected region. In this report, we present a case of associative prosopagnosia with no concomitant symptoms in a 76-year-old man. Brain magnetic resonance imaging detected a subcortical hemorrhage in the right temporal lobe. Using tractography based on diffusion tensor imaging, we visualized atrophy of the right inferior longitudinal fasciculus (ILF). This is the first time tractography has been used to show a clear association between associative prosopagnosia and ILF damage projecting from the rFG.